Sudden Cardiac Arrest

Growing concerns of Sudden Cardiac Arrest in India

A sudden cardiac arrest (SCA) or sudden cardiac death is a condition in which the heart suddenly stops beating. In turn, it prevents the flow of oxygen-rich blood to the brain and other organs. If SCA is not treated immediately, then the patient dies within minutes.

About 10% of the deaths in India is due to sudden cardiac arrest which is also the most common factor of death in the world.

Economic Times

Causes:

SCA occurs due to:

Risk factors:

  • Age – The risk of SCA increases with age due to the presence of other health conditions.
  • Gender – Men are more likely to be affected as compared to women. The risk of SCA in children is high if they have any inherited heart disease.
  • Ethnicity – African Americans and Blacks are at a higher risk, especially if they have other underlying conditions like hypertension, diabetes, and chronic kidney disease.
  • Ischemic heart disease – People with ischemic heart disease are at a higher risk.
  • Other heart conditions – Patients diagnosed with heart attack, heart failure, cardiac arrhythmias, coronary artery disease, and scarring or damage to the heart tissue have increased incidence of SCA.
  • Physical stress – Intense physical activity or exercise raises the risk in people who already have heart problems.
  • Unhealthy lifestyle habits – Obesity, smoking, sedentary lifestyle, and alcohol abuse elevate the risk of getting SCA.
  • Family history – People born with heart defects like coronary artery anomaly or those with a family history of arrhythmias are at a higher risk.
  • Drug abuse – Illicit drug use of cocaine and other addiction-forming drugs elevates the risk.
  • Medications – Certain drug overdose and medicine used to treat heart disease increases the risk.

What are the Signs and symptoms of Sudden Cardiac Arrest?

  • Dizziness or lightheadedness just before the patient faints
  • Loss of consciousness (fainting)
  • Unexplained shortness of breath
  • Racing heart
  • Chest pain
  • Seizures
  • Fatigue
  • Vomiting
  • Lack of palpable pulse
  • Nausea
  • Unable to breathe normally and make gasping noises

Complications:

Emergency treatment helps to prevent death due to SCA. After resuscitation, the following complications are associated with SCA:

  • Postcardiac arrest shock 
  • reduced heart function
  • Organ damage

Diagnosis: how is Sudden Cardiac Arrest diagnosed?

  • SCA happens without any warning and is rarely diagnosed as it is happening. Most often, it is diagnosed after it happens.
  • Diagnostic tests –
    • Electrocardiogram (ECG) – Detects the heart’s electrical activity and signs of heart damage due to ischemic heart disease.
    • Echocardiography (echo) – Helps identify areas of poor blood flow, previous injury to the heart muscle, and regions of the heart muscle that are not contracting properly.
    • Gated blood pool scan or MUGA (Multiple gated acquisition) tests – A radioactive substance is injected into the vein to show how well the heart pumps blood.
    • Cardiac Magnetic Resonance Imaging (MRI) 
    • Cardiac catheterization – To detect narrowed or blocked coronary arteries.
    • Electrophysiology study To record how the heart’s electrical system responds to electrical stimuli and certain medicines.
    • Blood tests The levels of potassium, magnesium, and other chemicals involved in the heart’s electrical signaling are detected.

Treatment: how is Sudden Cardiac Arrest treated?

  • Emergency treatment is done to restore the heart’s normal rhythm. Cardiopulmonary resuscitation (CPR) is immediately performed to keep blood and oxygen circulating to the brain and throughout the body.
  • Emergency treatment – Defibrillation is usually done to restore the vitals as well as consciousness immediately. CPR is performed till defibrillation can be done. 
    • Automated External Defibrillators (AEDs) – Untrained individuals can use a particular defibrillator to give electric shocks if a dangerous arrhythmia is detected.
    • Cardiopulmonary resuscitation (CPR) – The center of the chest is pushed down by at least 2 inches at the rate of 100 to 120 pushes per minute. The chest is allowed to come back to the normal position before the next push.
  • Surgical procedures – Long–term treatment in the hospital and other surgical procedures are done to treat the underlying condition responsible for the SCA. These include:
    • Coronary artery bypass grafting or coronary angioplasty – These restore blood flow via the narrowed or blocked arteries to treat the ischemic heart disease and prevent another SCA in the future.
    • Implantable cardioverter-defibrillator (ICD) – It is surgically placed in the skin in the chest to send electric shocks to control dangerous arrhythmias.
  • Medications to prevent sudden cardiac death –
    • Antiarrhythmic drugs – Lidocaine, amiodarone, etc. for acute and chronic therapy to prevent ventricular arrhythmias and sudden cardiac death.
    • Other drugs – Statins and drugs, acting on the renin-angiotensin-aldosterone system to treat the underlying heart conditions.

Prevention:

Living with SCA – 

  • Cardiac rehabilitation
  • Dietary intake rich in soluble fiber and low in saturated and trans fat
  • Managing a healthy weight
  • Managing stress
  • Quitting smoking

Preventing SCA –

  • Exercising regularly
  • Regularly taking the prescribed medicines to treat the underlying conditions
  • Controlling diabetes, high blood pressure, and high cholesterol
  • Limiting alcohol intake

When to see a doctor? :

Consult immediately with a cardiologist or cardiac electrophysiologist if chest pain or shortness of breath is experienced for prolonged periods. It is critical to call the emergency helpline number immediately if someone collapses or seems lifeless. The average cost of an AED for use at – home ranges from Rs. 65K to 2 lakhs. The price of a standard ICD surgery lies around Rs. 3.5 to 4.5 lakhs.

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